Notable Nursing: Update October 2013

Nurse Spearheads Community Fitness ProgramNurse Spearheads Community Fitness Program

To kick off the new year, Fairview Hospital, one of Cleveland Clinic’s eight regional hospitals in northeast Ohio, teamed with the city of Fairview Park to offer a fitness program. “Cleveland Clinic believes we need to go to the people rather than wait until they come to us sick,” says Rosemary Miles, BSN, RN, Manager for Community Health at Fairview Hospital. “We want to get out in communities, prevent illnesses and promote wellness.”

Miles organized the 8-week program, called Fit in Fairview, with the fitness director of the city’s recreation center. More than 200 people participated in the program, which ran from January 5 to March 2. It began with a health fair and physical assessment held at the recreation center. Fourteen PRN nurses conducted health screenings, including a lipid panel, blood pressure, height, weight, body mass index and a blood glucose test.

Participants met weekly, listened to a health professional give a 15-minute presentation, then walked around the track. The presentation topics were diverse. Among them, a dietitian discussed healthy eating, a physical therapist explained how to work out with weights, an oncologist shared the potential risks of excess weight and a sedentary lifestyle and a pharmacist warned against abusing over-the-counter diet pills.

At the start of the program, the group walked 12 laps around the track—or one mile. By the end, most people had increased their distance to 2.5 miles. In addition to the weekly group meetings, the recreation center opened its track to participants several other times throughout the week.

Program participants included city residents as well as hospital employees. Janet Pier, BSN, RN, was among those who joined in Fit in Fairview. “Wellness is the healthcare model of the future,” says Pier, RN Clinical Coordinator in the Quality Management Department of Fairview Hospital. “It’s important for nurses to partner with the community, demonstrate our own wellness and encourage other people to be active and accountable for their own wellness.”

Fit in Fairview was a success. Approximately 100 people took part in a follow-up health screening at the end of the program. In total, that group lost more than 300 pounds and walked more than 16,000 miles.

Community Hospital Makes Professional Development a PriorityRegional Hospital Makes Professional Development a Priority

Euclid Hospital values professional development and continuing education. “We continually encourage our nurses to go back to school, attend conferences and learn more about their profession because healthcare is ever-changing,” says Vickie Gardner, BSN, RN, Coordinator of Nursing Quality & Accreditation at Euclid Hospital. “It really empowers our nurses when their organization supports them in their endeavors to learn and grow.”

The hospital, part of the Cleveland Clinic health system, has a Nursing Professional Development Council (NPDC) comprised of the CNO, director of nursing, assistant nurse managers and a variety of frontline nurses. The NPDC organizes events and initiatives, such as the ones highlighted here, to promote continuous learning among Euclid Hospital’s 400 nurses.

  • Nursing Library Open House—A nursing library, located in the basement of Euclid Hospital, is open to staff 24/7. It features nursing and medical journals and a computer station, where nurses can access thousands of journals online. Space is set aside for collaborative projects, and the library has research software. Outside the library, a poster board encased in glass displays information on certification classes currently being offered.

    During Nurses Week, the library held a 4-hour open house during second shift. Members of the NPDC were available to answer questions. “The goal of the open house was to make nurses more comfortable with the library and introduce them to the resources there,” says Gardner.
  • Book Sale-Swap Program—Euclid Hospital developed this program for nurses to sell or share books purchased for BSN and MSN programs. When people are done using books, they drop them off at the library to donate or loan to other nurses. The library has a growing collection of books on everything from chemistry and nutrition to core nursing books on gerontology, pharmacology and more. “We have so many nurses going back to school,” says Gardner. “The book sale-swap program has been amazing.”
  • Review Books for Specialty Certifications—The medical staff donated money to buy a variety of review books, which are available in the nursing library. Between 2011 and 2012, there was a 58 percent increase in nurses with specialty certifications. As of May 2013, Euclid Hospital had 53 certified nurses.
  • Scholarship Programs—Euclid Hospital offers various financial incentives to nurses. An LPN to RN fund provides scholarships to several nurses annually who are pursuing an associate’s degree. The Debbie McGill Continuing Education Scholarship Fund, established in memory of a nurse, is awarded each year to nurses to cover registration fees for continuing education seminars and conferences. Grants are available for nurses enrolled in a master’s degree program.

Nurses Lead Mobility StudyNurses Lead Mobility Study

The neurological ICU at Cleveland Clinic’s main campus completed phase 2 of an early progressive mobility protocol study. Kate Klein, MS, RN, ACNP-BC, CCRN, presented findings at the 9th annual Nursing Research Conference at Cleveland Clinic in May.

“About three to four years ago, a lot of our patients were not getting out of bed and that seemed problematic to us,” says Klein, an acute care nurse practitioner in neurocritical care. “Early mobility is one of the interventions that is really good for a patient’s recovery.” As in other patient populations, early mobility in neurological ICU patients reduces the risk of hospital-acquired conditions, avoids prolonged hospital stays due to weakness and deconditioning, and lessens patients’ rehabilitation needs after discharge.

Malissa Mulkey, MSN, CCRN, CCNS, who works in the neurological ICU, drafted early mobility protocols. Prior to their implementation on Cleveland Clinic’s main campus in February 2012, the unit participated in phase 1 of the study: It collected pre-implementation data measuring patients’ mobility on a scale of one to 16. One indicates a patient in bed with passive range of motion, while patients on level 16 can walk with assistance or independently.  “We wanted to study what sort of impact mobilizing patients early has on clinical outcomes,” says Klein. (For more information on the protocol, read the “News in Neurology” article in the Spring 2012 issue of Notable Nursing newsletter.)

Phase 2 ran from May to September 2012. During that time, the neurological unit purchased a mobile lift for patients. Nurses received abundant education on the protocol and using the mobile lift and the unit’s beds, which feature progressive mobility features. Nurses then relied on the protocol to lead them as they advanced patients through increasing degrees of mobility. Research nurses gathered information on clinical outcomes and surveyed patients prior to discharge on their level of depression, anxiety and hostility. At the conclusion of phase 2, Klein compared the differences between pre- and post-implementation data.

The results have not been published yet, but Klein says the findings are positive. “Instituting an early progressive mobility protocol resulted in significant improvement in level of mobility achieved, ICU and hospital length of stay,” she says. “There were favorable trends toward improvement with other clinical outcomes, such as depression and anxiety, yet more research is needed.”

Phase 3 of the study, which just began, will measure the sustainability of the protocol. “Once the education is done and the newness wears off, how will that impact early mobility?” says Klein. “We’re hoping that nurses who participated in phase 2 will mentor new nurses and carry on the protocol.”